Invoice Doctor General Practitioner in Kenya Nairobi –Free Word Template Download with AI
Address: Westlands Medical Centre, 3rd Floor, Lenana Road
City: Kenya Nairobi, 00100
Phone: +254 722 555 123
Email: [email protected]
KRA PIN: P051234567Z
Medical Practitioners & Dentists Council of Kenya (MPDC) Reg. No: GP/12345/2015
INVOICE
Invoice Number: INV-2024-0892
Date Issued: 15th January 2024
Due Date: 30th January 2024
Payment Terms: Net 15 Days
Bill To:
Organization: Safaricom Limited
Department: Human Resources - Employee Wellness
Address: Safaricom House, Chiromo Road
City: Kenya Nairobi, 00100
Attn: Finance Department
Email: [email protected]
Patient Information:
Patient Name: Jane Wanjiku Kamau
ID Number: 28475631
Date of Birth: 12th March 1985
Insurance Provider: Jubilee Health Insurance
Policy Number: JHI-EMP-789456
Group Number: SAF-GRP-001
| # | Date of Service | Description of Medical Services | Quantity | Unit Price (KES) | Total (KES) |
|---|---|---|---|---|---|
| 1 | 10/01/2024 | Initial Consultation - General Practitioner Assessment for hypertension management and routine health screening | 1 | 3,500.00 | 3,500.00 |
| 2 | 10/01/2024 | Comprehensive Physical Examination including cardiovascular, respiratory, and abdominal assessment | 1 | 2,000.00 | 2,000.00 |
| 3 | 10/01/2024 | Blood Pressure Monitoring and Documentation (3 readings taken) | 1 | 500.00 | 500.00 |
| 4 | 10/01/2024 | Prescription of Antihypertensive Medication (Amlodipine 5mg) - 30 day supply | 1 | 1,200.00 | 1,200.00 |
| 5 | 10/01/2024 | Laboratory Referral and Coordination - Full Blood Count, Lipid Profile, and Renal Function Tests | 1 | 4,500.00 | 4,500.00 |
| 6 | 12/01/2024 | Follow-up Consultation - Review of laboratory results and adjustment of treatment plan | 1 | 2,500.00 | 2,500.00 |
| 7 | 12/01/2024 | Patient Education and Lifestyle Counseling - Dietary modifications and exercise recommendations | 1 | 1,000.00 | 1,000.00 |
| 8 | 12/01/2024 | Medical Certificate Issuance for workplace accommodation (2 days sick leave) | 1 | 800.00 | 800.00 |
| 9 | 14/01/2024 | Administrative Fee - Processing of insurance claim documentation and submission to Jubilee Health Insurance | 1 | 500.00 | 500.00 |
| 10 | 14/01/2024 | Medical Records Management and Electronic Health Record (EHR) Documentation | 1 | 300.00 | 300.00 |
| Subtotal: | KES 16,800.00 |
| VAT (16%): | KES 2,688.00 |
| Insurance Coverage (Jubilee Health): | -KES 14,000.00 |
| Corporate Discount (Safaricom Employee): | -KES 500.00 |
| Amount Due: | KES 4,988.00 |
Payment Instructions:
Bank Transfer:
Bank Name: Equity Bank Kenya Limited
Branch: Westlands Branch, Kenya Nairobi
Account Name: Dr. James Mwangi General Practice
Account Number: 0123456789
Branch Code: 0105
M-Pesa Paybill:
Paybill Number: 522522
Account Number: INV-2024-0892
Reference: Please use Invoice Number INV-2024-0892 as payment reference for proper reconciliation.
Important Notes and Terms:
1. This invoice is issued in accordance with the Medical Practitioners and Dentists Act of Kenya and complies with the regulations set forth by the Medical Practitioners and Dentists Council of Kenya (MPDC).
2. All services rendered were provided by a qualified Doctor General Practitioner registered and licensed to practice in Kenya Nairobi.
3. Payment is due within 15 days from the date of invoice issuance. Late payments may incur a penalty of 2% per month on the outstanding balance.
4. Insurance claims have been submitted directly to Jubilee Health Insurance. The amount due represents the patient's co-payment and any non-covered services as per the insurance policy terms.
5. Please retain this invoice for your records and for tax purposes. This document serves as an official receipt upon payment confirmation.
6. For any queries regarding this invoice, please contact our billing department at [email protected] or call +254 722 555 123 during business hours (Monday to Friday, 8:00 AM to 5:00 PM East Africa Time).
7. All medical services were provided at our clinic located in Kenya Nairobi, Westlands Medical Centre. Travel or home visit fees are not applicable to this invoice.
8. This invoice is valid for 90 days from the date of issuance. After this period, a new invoice may be generated with updated terms.
Authorized by:
Dr. James MwangiDoctor General Practitioner
MPDC Reg. No: GP/12345/2015
Received and Accepted by:
_________________________Name and Signature
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